Sound Advice Vol III
Another pearly email from one of the field’s fathers, and another pic that has no relation at all
A colleague saw a healthy 4 y/o with a typical viral syndrome. In the nursing triage note one of many complaints was chest pain. The doc likely did not read that note, or ignored it, and never addressed it in the chart. He concentrated on abdominal pain and vomiting, which were also complaints. The child seemed OK, was sent home, and died 13 hrs later of myocarditis. Myocarditis sometimes has EKG and troponin abnormalities, but not always. They were not ordered. Not sure how this would have been different, but not addressing the chest pain will cream him on this one.
Axiom: Always read and address the nursing notes. If there was no chest pain, and he said, “contrary to nurse note, there was no chest pain on my detailed eval” or “chest pain investigated in detail and not relevant” he likely would have been better off. Imagine trying to explain this one to the parents or jury, of course everyone knows chest pain comes from the heart, dah….